Outdoor School of Science and Conservation
Tulare County Office of Education
_____________________________________ has applied for a position with SCICON, the outdoor school of science and conservation for Tulare County Office of Education. In this capacity the applicant will be working with sixth grade students in a residential setting. The applicant will be responsible for instruction and supervision of the twelve year old students.
Please give careful consideration to the questions listed below. When completed please send to:
Fax to: (559) 539-2643 or Mail to: SCICON, P.O. Box 339 Springville, CA 93265
If you prefer, you may also call at (559) 539-2642 to speak with Rick Mitchell, SCICON Program Director, or Dianne Shew, SCICON Program Specialist, at (559) 539-3513.
Thank you for your time and effort!
INFORMATION ABOUT YOU:
Name of Reference: ______________________________________________________________
Phone: ( )_____________________________________
Employed by: ___________________________________________________________________
1. How long have you known this applicant? ______________________
2. Indicate the nature of your association with the applicant. ___employer ___supervisor ___ other __________________________
3. In what situations have you observed this person in a teaching role? Do you feel he/she would be an effective educator in an outdoor setting? Explain.
4. Would you place a child under the instruction and supervision of this individual in an outdoor environ- mental camp? ___Yes ___No? Explain.
5. From your observations, would you describe the applicant as a leader or follower? How successful has he/she been at interacting with peers or young people? Explain any problems or concerns.
6. In your opinion, is the applicant a suitable role model for 12 year old youths of both sexes? ___Yes ___No Please explain.
|PLEASE RATE THE APPLICANT||Excellent||Good||Needs Development||Not Observed|
|Appearance and hygiene|
|Health, energy and endurance|
|Emotional maturity and stability||
|Sense of responsibility|
|Attendance and punctuality|
|Ability to accept constructive criticism|
|Flexibility and adaptability|
|Quality of writing skills|
|Attention to details|
|Respect for facilities and equipment|
8. Please check those qualities which best describe the applicant. (Check as many as are applicable):
___ Assertive ___ Cheerful ___ Creative ___ Dependable ___ Determined ___ Easy going
___ Empathetic ___ Follower ___ Leader ___ Loyal ___ Moody ___ Outgoing ___ Patient
___ Permissive ___ Private ___ Punitive ___ Quiet ___ Self Starter ___ Serious ___ Shy
___ Hard worker___ Team Player ____ Individualist ____Flexible ____ Rigid ____ Passive
_____ I recommend hiring without reservations.
_____ I recommend hiring with some reservations.
_____ I recommend applicant not be hired.
Signature ____________________________________ Date __________________________